Yersiniosis

Yersiniosis is a relatively uncommon infection contracted through the consumption of undercooked meat products, unpasteurized milk, or water contaminated by the bacteria.

Usually, someone with an infection caused by Yersinia bacteria recovers within a few days without medical treatment (in some cases, doctors prescribe antibiotics).

About Yersiniosis

Of the three main types of yersiniosis that affect people, Yersinia enterocolitica (bacteria that thrive in cooler temperatures) are responsible for most infections in the United States. Still, there is only 1 confirmed case per 100,000 people each year.

The bacteria can infect the digestive tracts of humans, cats, dogs, pigs, cattle, and goats. People can contract it by eating or handling contaminated foods such as raw or undercooked meat, or by drinking untreated water or unpasteurized milk that has been contaminated.

An infant can be infected if a parent or caretaker handles contaminated food without cleaning up adequately before handling the infant's toys, bottles, or pacifiers.

Signs and Symptoms

Symptoms of yersiniosis appear 4 to 7 days after exposure and can last up to 3 weeks. They include fever, stomach pain, nausea, vomiting, and bloody diarrhea. Sometimes, older kids also get pain in the lower right side of the abdomen, which can mimic appendicitis.

If your child has these symptoms, call your doctor. For infants, it's particularly important to call the doctor as soon as symptoms appear to prevent the infection from leading to other health problems.

In rare cases, the infection can cause a skin rash or joint pain that appears a month after the initial symptoms. But these symptoms go away without treatment.

Treatment

Diarrhea caused by yersiniosis generally goes away on its own, though in some cases antibiotics are prescribed. In infants, however — particularly those who are 3 months old or younger — it can develop into a more serious condition called bacteremia, an infection of the blood. Infants who contract yersiniosis are usually treated in a hospital.

Depending on the severity of the diarrhea, your doctor may suggest modifying your child's diet for 1 to 2 days and encouraging your child to drink more fluids (which may include drinks with electrolytes to replace body fluids quickly).

If your child is frequent bouts of diarrhea, watch for signs of dehydration, including:

• severe thirst
• dry mouth or tongue
• sunken eyes
• dry skin
• infrequent urination
• in infants, a dry diaper for several hours

Prevention

To reduce the risk of yersiniosis, take these precautions:

• Don't serve eat raw or undercoooked meat.

• Drink and serve only pasteurized milk or milk products.

• Wash hands with soap and water particularly before eating and preparing food; before touching infants or their toys, bottles, or pacifiers; and after contact with animals or handling raw meat.

• Use separate cutting boards for meat and other foods.

• Clean all cutting boards, countertops, and utensils with soap and hot water after preparing raw meat.

• Always cook meat thoroughly before you eat it, especially pork products.

• Dispose of animal feces and sanitize anything they have touched.

• Avoid drinking directly from natural water sources such as ponds and mountain streams, particularly if the water is near farmland where cattle, pigs, or goats are raised.

• As you care for a family member who has diarrhea, remember to wash your hands thoroughly before touching other people and before handling food.

• If your pet dog or cat has diarrhea, wash your hands frequently as you care for it, and check with your veterinarian about treatment and/or contagiousness.

When to Call the Doctor

Call your doctor if your child:

• has diarrhea streaked with blood
• has been vomiting
• shows any signs of dehydration

With some rest, kids with yersiniosis usually make a full recovery quickly.

Shigella Infections

About

Shigella are bacteria that can infect the digestive tract and cause a wide range of symptoms, from diarrhea, cramping, vomiting, and nausea, to more serious complications and illnesses. Infections, called shigellosis, sometimes go away on their own; in others, antibiotics can shorten the course of the illness.

Shigellosis, which is most common during the summer months, usually affects kids 2 to 4 years old, and rarely infects infants younger than 6 months old.

These infections are very contagious and can be prevented with good hand washing practices.

Signs and Symptoms

Shigella bacteria produce toxins that can attack the lining of the large intestine, causing swelling, ulcers on the intestinal wall, and bloody diarrhea.

The severity of the diarrhea sets shigellosis apart from regular diarrhea. In kids with shigellosis, the first bowel movement is often large and watery. Later bowel movements may be smaller, but the diarrhea may have blood and mucus in it.

Other symptoms of shigellosis include:

• abdominal cramps
• high fever
• loss of appetite
• nausea and vomiting
• painful bowel movements

In very severe cases of shigellosis, a person may have convulsions (seizures), a stiff neck, a headache, extreme tiredness, and confusion. Shigellosis can also lead to dehydration and in rare cases, other complications, like arthritis, skin rashes, and kidney failure.

Some children with severe cases of shigellosis may need to be hospitalized.

Contagiousness

Shigellosis is very contagious. Someone may become infected by coming into in contact with something contaminated by stool from an infected person. This includes toys, surfaces in restrooms, and even food prepared by someone who is infected. For instance, kids who touch a contaminated surface such as a toilet or toy and then put their fingers in their mouths can become infected. Shigella can even be carried and spread by flies that have touched contaminated stool.

Because it doesn't take many Shigella bacteria to cause an infection, the illness spreads easily in families and childcare centers. The bacteria also may spread in water supplies in areas with poor sanitation. Shigella can be passed in the person's stool for about 4 weeks even after the obvious symptoms of illness have resolved (although antibiotic treatment can reduce the excretion of Shigella bacteria in the stool).

Prevention

The best way to prevent the spread of Shigella is by frequent and careful hand washing with soap, especially after they use the toilet and before they eat. This is especially important in childcare settings.

If you're caring for a child who has diarrhea, wash your hands before touching other people and before handling food. (Anyone with a diarrhea should not prepare food for others.) Be sure to frequently clean and disinfect any toilet used by someone with shigellosis.

Diapers of a child with shigellosis should be disposed of in a sealed garbage can, and the diaper area should be wiped with disinfectant after use. Young children (especially those still in diapers) with shigellosis or with diarrhea of any cause should be kept away from other kids.

Proper handling, storage, and preparation of food can also help prevent Shigella infections. Cold foods should be kept cold and hot foods should be kept hot to prevent bacterial growth.

Diagnosis and Treatment

To confirm the diagnosis of shigellosis, your doctor may take a stool sample to be tested for Shigella bacteria. Blood tests and other tests can also rule out other possible causes of the symptoms, especially if your child has a large amount of blood in the stool.

Some cases of shigellosis require no treatment, but antibiotics often will be given to shorten the illness and to prevent the spread of bacteria to others.

If the doctor prescribes antibiotics, give them as prescribed. Avoid giving your child nonprescription medicines for vomiting or diarrhea unless the doctor recommends them, as they can prolong the illness. Acetaminophen (such as Tylenol) can be given to reduce fever and make your child more comfortable.

To prevent dehydration, follow your doctor's guidance about what your child should eat and drink. Your doctor may recommend a special drink called an oral rehydration solution, or ORS (such as Pedialyte), to replace body fluids quickly, especially if the diarrhea has lasted 2 or 3 days or more.

Children who become moderately or severely dehydrated or those with other more serious illnesses may need to be hospitalized to be monitored and receive treatment such as intravenous (IV) fluid therapy or antibiotics.

When to Call the Doctor

Call the doctor if your child has signs of a Shigella infection, including diarrhea with blood or mucus, accompanied by abdominal pain, nausea and vomiting, or high fever.

Kids with diarrhea can quickly become dehydrated, which can lead to serious complications. Signs of dehydration include:

• thirst
• irritability
• restlessness
• lethargy
• dry mouth, tongue, and lips
• sunken eyes
• a dry diaper for several hours in infants or fewer trips to the bathroom to urinate in older children

If you see any of these signs, call the doctor right away.

Salmonella Infections

A salmonella infection is a foodborne illness caused by the salmonella bacteria carried by some animals, which can be transmitted from kitchen surfaces and can be in water, soil, animal feces, raw meats, and eggs. Salmonella infections typically affect the intestines, causing vomiting, fever, and other symptoms that usually resolve without medical treatment.

You can help prevent salmonella infections by not serving any raw meat or eggs, and by not keeping reptiles as pets, particularly if you have very young children.

Hand washing is a powerful way to guard against salmonella infections, so it's essential to teach kids to wash their hands, particularly after trips to the bathroom and before handling food in any way.

Salmonella Basics

Not everyone who ingests salmonella bacteria will become ill. Children, especially infants, are the most likely candidates to get sick from it. About 50,000 cases of salmonella infection are reported in the United States each year and about one third of those are in kids 4 years old or younger.

The type of salmonella most commonly associated with infections in humans is called nontyphoidal salmonella. It is carried by chickens, cows, and reptiles such as turtles, lizards, and iguanas.

Another, rarer form of salmonella, typhoidal salmonella (typhoid fever), is carried only by humans and is usually transmitted through direct contact with the fecal matter of an infected person. This kind of salmonella infection can lead to high fever, abdominal pain, headache, malaise, lethargy, skin rash, constipation, and delirium. It occurs primarily in developing countries without appropriate systems for handling human waste.

Signs and Symptoms

A salmonella infection generally causes nausea, vomiting, abdominal cramps, diarrhea (sometimes bloody), fever, and headache. Because many different kinds of illnesses can cause these symptoms, most doctors will take a stool sample to make an accurate diagnosis.

Symptoms of most salmonella infections usually appear within 3 days of contamination and typically go away without medical treatment.

In cases of typhoid fever caused by salmonella bacteria, early symptoms are the same. But in the second week, the liver and spleen can become enlarged, and a distinctive "rose spotted" skin rash may appear. From there, the infection can cause other health problems, like meningitis and pneumonia.

People at risk for more serious complications from a salmonella infection include those who:

• have compromised immune systems (such as people with HIV)
• take cancer-fighting drugs
• have sickle cell disease or an absent or nonfunctioning spleen
• take chronic stomach acid suppression medication

In these higher-risk groups, most doctors will treat an infection with antibiotics to prevent it from spreading to other parts of the body and causing additional health problems.

Prevention

You have many ways to help prevent salmonella bacteria from making your family sick. Most salmonella bacteria appear in animal products and can be killed by the heat from cooking. So it's important to make sure that you don't serve raw or undercooked eggs, poultry, or meat. Microwaving is not a reliable way to kill the salmonella bacteria.

Because salmonella bacteria can contaminate even intact and disinfected grade A eggs, avoid serving poached eggs or eggs that are served sunny-side up.

Salmonella also can be spread through cross-contamination, so when you're preparing meals, keep uncooked meats away from cooked and ready-to-eat foods. In addition, thoroughly wash your hands, cutting boards, counters, and knives after handling uncooked foods.

Some foods may contain unrecognized raw-food products and should be avoided. Caesar salad dressing, the Italian dessert tiramisu, homemade ice cream, chocolate mousse, eggnog, cookie dough, and frostings can contain raw eggs. Unpasteurized milk and juices also can be contaminated with salmonella.

Fecal matter is often the source of salmonella contamination, so hand washing is extremely important, particularly after using the toilet and before preparing food.

Take care to avoid contact with the feces of family pets — especially reptiles. Wash your hands thoroughly after handling an animal and ensure that no reptiles are permitted to come into contact with an infant. Even healthy reptiles (especially turtles and iguanas) are not appropriate pets for small children and should not be in the same house as an infant.

Treatment

If your child has a salmonella infection and a healthy immune system, your doctor may let the infection pass without treatment. But any time your child develops a fever, headache, or bloody diarrhea, call the doctor to rule out any other problems.

If your child is infected and has a fever, you may want to give acetaminophen to reduce his or her temperature and relieve cramping. As with any infection that causes diarrhea, it's important to give your child plenty of liquids to avoid dehydration.

Rotavirus

About Rotavirus

Almost all kids have had a rotavirus infection by the time they're 5 years old. Rotavirus is one of the most common causes of diarrhea, and severe infection (rotavirus gastroenteritis) is the leading cause of severe, dehydrating diarrhea in infants and young children.

Rotavirus infections are responsible for approximately 3 million cases of diarrhea and 55,000 hospitalizations for diarrhea and dehydration in children under 5 years old each year in the United States.

Although these infections cause relatively few U.S. deaths, diarrhea caused by rotavirus causes more than half a million deaths worldwide every year. This is especially true in developing countries, where nutrition and health care are not optimal.

Signs and Symptoms

Kids with a rotavirus infection have fever, nausea, and vomiting, often followed by abdominal cramps and frequent, watery diarrhea. Kids may also have a cough and runny nose. As with all viruses, though, some rotavirus infections cause few or no symptoms, especially in adults.

Sometimes the diarrhea that accompanies a rotavirus infection is so severe that it can quickly lead to dehydration. Signs of dehydration include: thirst, irritability, restlessness, lethargy, sunken eyes, a dry mouth and tongue, dry skin, fewer trips to the bathroom to urinate, and (in infants) a dry diaper for several hours.

Contagiousness

In the United States, rotavirus infection outbreaks are common during the winter and spring months. It is particularly a problem in childcare centers and children's hospitals because rotavirus infection is very contagious.

The virus passes in the stool of infected people before and after they have symptoms of the illness. Kids can become infected if they put their fingers in their mouths after touching something that has been contaminated. Usually this happens when kids don't wash their hands often enough, especially before eating and after using the toilet.

People who care for children, including health care and childcare workers, also can spread the virus, especially if they don't wash their hands after changing diapers.

Prevention

The American Academy of Pediatrics (AAP) now recommends a rotavirus vaccine be included in the lineup of routine immunizations given to all infants.

The RotaTeq vaccine has been found to prevent approximately 75% of cases of rotavirus infection and 98% of severe cases. Another vaccine, Rotarix, also is available and is effective in preventing rotavirus infection. Your doctor will have the most current information about these vaccines.

A previous rotavirus vaccine was taken off the market in 1999 because it was linked to an increased risk for intussusception, a type of bowel obstruction, in young infants. Neither RotaTeq nor Rotarix have been found to have this increased risk.

Frequent hand washing is the best tool to limit the spread of rotavirus infection. Kids who are infected should stay home from childcare groups until their diarrhea has ended. In hospitals, rotavirus outbreaks are controlled by isolating infected patients and following strict hand-washing procedures.

Professional Treatment

An infant or toddler who becomes moderately or severely dehydrated may need to be treated in a hospital with intravenous (IV) fluids to bring the body's fluid and salt levels back to normal. Most older kids can be treated at home.

Your doctor may need to test your child's blood, urine, or stool to confirm that the diarrhea is being caused by rotavirus and not by bacteria. Because antibiotics do not work against illnesses caused by viruses, the doctor will not prescribe antibiotics to treat a rotavirus infection.

Home Treatment

To prevent dehydration, follow your doctor's guidance about what your child should eat and drink. Your doctor may suggest that you give your child special drinks that replace body fluids, especially if the diarrhea has been going on for longer than 2 or 3 days.

In general, kids with mild diarrhea who are not dehydrated should continue to eat normally but should receive more fluids. (Fruit juices and soft drinks can make diarrhea worse and should be avoided.) Those who have mild to moderate dehydration should be given an oral rehydration solution in small, frequent amounts to correct the dehydration and then should go back to eating normally. Children who are breastfed should be breastfed throughout.

A child who is vomiting will need to eat smaller amounts more frequently. Follow your doctor's guidance and avoid giving your child store-bought medicines for vomiting or diarrhea unless your doctor recommends them.

When to Call the Doctor

Call the doctor for advice if your child has signs of a rotavirus infection, including watery diarrhea, fever, nausea, and vomiting. Call immediately if your child is showing signs of dehydration.

Pinworm

Pinworm is an intestinal infection caused by tiny parasitic worms. One of the most common roundworm infections, pinworm infections affect millions of people each year, particularly schoolchildren.

But if your child develops a pinworm infection, don't worry. Pinworms don't cause any harm (just itching), and it won't take long to get rid of them. And people who have pinworms aren't dirty — kids can get pinworms no matter how often they take a bath.

How Pinworm Infections Spread

Pinworm infections (also known as "seatworm infection," "threadworm infection," "enterobiasis," or "oxyuriasis") are contagious.

People become infected by unknowingly ingesting microscopic pinworm eggs that can be found on contaminated hands and surfaces, such as:

• bed linens
• towels
• clothing (especially underwear and pajamas)
• toilets
• bathroom fixtures
• food
• drinking glasses
• eating utensils
• toys
• kitchen counters
• desks or lunch tables at school
• sandboxes

The eggs pass into the digestive system and hatch in the small intestine. From the small intestine, pinworm larvae continue their journey to the large intestine, where they live as parasites — their heads attached to the inside wall of the bowel.

About 1 to 2 months after a person acquires the pinworm eggs, adult female pinworms begin migrating from the large intestine to the area around the rectum. There, they will lay new pinworm eggs, which trigger itching around the rectum.

When someone scratches the itchy area, microscopic pinworm eggs are transferred to their fingers. Contaminated fingers can then carry pinworm eggs to the mouth, where they are reingested, or to various surfaces, where they can live for 2 to 3 weeks.

If you're wondering if your family pet could give your child a pinworm infection, it can't. Pinworms don't come from animals.

Signs and Symptoms

Often, someone can have a pinworm infection without having any symptoms. When symptoms are present, the most common one is itching around the rectum and restless sleep. The itching is usually worse at night and is caused by worms migrating to the area around the rectum to lay their eggs. In girls, pinworm infection can spread to the vagina and cause a vaginal discharge.

If your child has a pinworm infection, you can see worms in the anal region, especially if you look about 2 or 3 hours after your child has fallen asleep. You might also see the worms in the toilet after he or she goes to the bathroom. They look like tiny pieces of white thread and are really small — about as long as a staple. You might also see them on your child's underwear in the morning.

Diagnosis and Treatment

Your doctor may ask you to help make the diagnosis of pinworm by placing a sticky piece of clear cellophane tape against your child's rectum. Pinworm eggs will stick to the tape and can be seen under a microscope in a laboratory. The doctor might also take some samples from under a child's fingernails to look for eggs.

If your child has a pinworm infection, the doctor will prescribe an antiworm medication that is given in one dose and repeated in 2 weeks. The doctor may decide to treat the entire family, especially if it is a recurrent infection. Although the medicine takes care of the worm infection, the itching may last about a week after the medicine is taken. So the doctor may also give your child a cream or other medication to help stop the itching.

Frequent hand washing and routine household cleaning measures (including frequent changing of underwear, and washing everyone's pajamas and bed linens) also will help reduce the spread of pinworm infection to the family.

When to Call the Doctor

Call the doctor if your child complains of an itchiness or he or she always seems to be scratching the anal or vaginal area.

Also ask about whether pinworms could be to blame if your child has trouble sleeping or has begun to wet the bed. (Pinworms can irritate the urethra — the channel through which urine leaves the bladder and exits the body — and lead to bedwetting.)

Prevention

Here are a few ways to prevent pinworm infections in your family:

• Remind kids to wash their hands often, especially after using the toilet, after playing outside, and before eating.
• Make sure your kids shower or bathe every day and change underwear daily.
• Keep kids' fingernails short and clean.
• Tell kids not to scratch around their bottom or bite their nails.
• Wash your kids' pajamas every few days.

If your child has a pinworm infection, all members of your family will need to be treated with medication to help prevent the infection from coming back.

Remember that pinworms are quite common among kids and aren't harmful. By taking a short course of medication and following some prevention tips, you'll be rid of the worms in no time.

Helicobacter pylori

The bacteria H. pylori (Helicobacter pylori) usually don't cause problems in childhood. However, if left untreated the bacteria can lead to digestive illnesses, including gastritis (the irritation and inflammation of the lining of the stomach), peptic ulcer disease (characterized by sores that form in the stomach or the upper part of the small intestine, called the duodenum), and even stomach cancer later in life.

These bacteria are found worldwide, but especially in developing countries, where up to 10% of children and 80% of adults can have laboratory evidence of an H. pylori infection — usually without having symptoms.

Signs and Symptoms

Anyone can have an H. pylori infection without knowing it as most H. pylori infections are "silent" and produce no symptoms. When the bacteria do cause symptoms, they're usually either symptoms of gastritis or peptic ulcer disease.

In kids, symptoms of gastritis may include nausea, vomiting, and frequent complaints about pain in the abdomen. However, these symptoms are seen in many childhood illnesses.

H. pylori, which used to be called Campylobacter pylori, can also cause peptic ulcers (commonly known as stomach ulcers). In older kids and adults, the most common symptom of peptic ulcer disease is a gnawing or burning pain in the abdomen, usually in the area below the ribs and above the navel. This pain often gets worse on an empty stomach and improves as soon as the person eats food, drinks milk, or takes antacid medicine.

Kids who have peptic ulcer disease can have ulcers that bleed, causing hematemesis (bloody vomit or vomit that looks like coffee grounds) or melena (stool that's black, bloody, or looks like tar). Younger children with peptic ulcer disease may not have symptoms as clear-cut, so their illness may be harder to diagnose.

Contagiousness

Scientists suspect that H. pylori infection may be contagious because the infection seems to run in families and is more common where people live in crowded or unsanitary conditions. Although research suggests that infection is passed from person to person, exactly how this happens isn't really known.

Diagnosis

Doctors can make the diagnosis of an H. pylori infection by using many different types of tests. Your doctor may:

• look at the stomach lining directly. This is performed under sedation and involves inserting an endoscope — a small, flexible tube with a tiny camera on the end — down the throat and into the stomach and duodenum. The doctor may then take samples of the lining to be checked in the laboratory for microscopic signs of infection and for H. pylori bacteria.

• do blood tests, which can detect the presence of H. pylori antibodies. Blood tests are easy to perform, although a positive test may indicate exposure to H. pylori in the past and not an active infection.

• do breath tests, which can detect carbon broken down by H. pylori after the patient drinks a solution. Breath tests are time consuming and provide no information about the severity of infection. This type of test may be difficult to perform in young children.

• do stool tests, which can detect the presence of H. pylori proteins in the stool. Like breath testing, stool tests indicate the presence of H. pylori but give no information about the severity of infection.

Treatment

Doctors treat H. pylori infections using antibiotics. Because a single antibiotic may not kill the bacteria, your child will normally be given a combination of antibiotics. Usually, the doctor will also give antacids or acid-suppressing drugs to neutralize or block production of stomach acids.

If your child has symptoms of bleeding from the stomach or small intestine, these symptoms will be treated in a hospital.

Because H. pylori infection can be cured with antibiotics, the most important home treatment is to give your child any prescribed antibiotic medicine on schedule for as long as the doctor has directed.

One way to help soothe the abdominal pain is by following a regular meal schedule. This means planning meals so that your child's stomach doesn't remain empty for long periods. Eating five or six smaller meals each day may be best, and your child should take some time to rest after each meal.

It's also important to avoid giving your child aspirin, aspirin-containing medicines, ibuprofen, or anti-inflammatory drugs because these may irritate the stomach or cause stomach bleeding.

With prolonged antibiotic therapy, H. pylori gastritis and peptic ulcer disease (especially ulcers in the duodenum, a portion of the small intestine) can often be cured.

Prevention

Right now, there's no vaccine against H. pylori. And because transmission isn't clearly understood, prevention guidelines aren't available. However, it's always important to make sure you and your family:

• Wash your hands thoroughly.
• Eat food that's been properly prepared.
• Drink water from a safe source.

When to Call the Doctor

Call your doctor immediately if your child has any of these symptoms:

• severe abdominal pain
• vomit that's bloody or looks like coffee grounds
• stool that's bloody, black, or looks like tar
• persistent gnawing or burning pain in the area below the ribs that improves after eating, drinking milk, or taking antacids

However, it's important to remember kids can get stomachaches for many reasons — like indigestion, viruses, tension and worry, and appendicitis. Most stomachaches are not caused by H. pylori bacteria.

Giardiasis

Giardiasis, an illness that affects the digestive tract, is caused by a microscopic parasite called Giardia lamblia. The parasite attaches itself to the lining of the small intestines in humans, where it sabotages the body's absorption of fats and carbohydrates from digested foods.

Giardia is one of the chief causes of diarrhea in the United States, and is transmitted through contaminated water. It can survive the normal amounts of chlorine used to purify community water supplies, and can live for more than 2 months in cold water. As few as 10 of the microscopic parasites in a glass of water can cause a severe case of giardiasis in a human being who drinks it.

Young kids are three times more likely to have giardiasis than adults, which leads some experts to believe that our bodies gradually develop some form of immunity to the parasite as we grow older. But it isn't unusual for an entire family to have giardiasis, with some family members having diarrhea, some just crampy abdominal pains, and others with few or no symptoms.

Signs and Symptoms

It's estimated that between 1% and 20% of the U.S. population has giardiasis, and this figure may be 20% or higher in developing countries, where giardiasis is a major cause of epidemic childhood diarrhea. But more than two thirds of people who are infected may have no signs or symptoms of illness, even though the parasite is living in their intestines.

When the parasite does cause symptoms, the illness usually begins with severe watery diarrhea, without blood or mucus. Giardiasis affects the body's ability to absorb fats from the diet, so the diarrhea contains unabsorbed fats. That means that the diarrhea floats, is shiny, and smells very bad.

Other symptoms include:

• abdominal cramps
• large amounts of intestinal gas
• an enlarged belly from the gas
• loss of appetite
• nausea and vomiting
• sometimes a low-grade fever

These symptoms may last for 5 to 7 days or longer. If they last longer, a child may lose weight or show other signs of poor nutrition.

Sometimes, after acute (or short-term) symptoms of giardiasis pass, the disease begins a chronic (or more prolonged) phase.

Symptoms of chronic giardiasis include:

• periods of intestinal gas
• abdominal pain in the area above the navel
• poorly formed, "mushy" bowel movements (poop)

Prevention

Here are some ways to protect your family from giardiasis:

• Drink only from water supplies that have been approved by local health authorities.

• Bring your own water when you go camping or hiking, instead of drinking from sources like mountain streams.

• Wash raw fruits and vegetables well before you eat them.

• Wash your hands well before you cook food for yourself or for your family.

• Encourage your kids to wash their hands after every trip to the bathroom and especially before eating. If someone in your family has giardiasis, wash your hands often as you care for him or her.

• Have your kids wash their hands well after handling anything in "touch tanks" in aquariums, a potential source of giardiasis.
• Have your water checked on a regular basis if it comes from a well.

Also, it's questionable whether infants and toddlers still in diapers should be sharing public pools. But certainly they should not if they're having diarrhea or loose stools (poop).

Contagiousness

People and animals (mainly dogs and beavers) who have giardiasis can pass the parasite in their stool. The stool can then contaminate public water supplies, community swimming pools, and "natural" water sources like mountain streams. Uncooked foods that have been rinsed in contaminated water may also spread the infection.

In child-care centers or any facility caring for a group of people, giardiasis can easily pass from person to person. At home, an infected family dog with diarrhea may pass the parasite to human family members who take care of the sick animal.

Diagnosis

Doctors confirm the diagnosis of giardiasis by taking stool samples and sending them to the lab to be examined for Giardia parasites. Several samples may be needed before the parasites are found.

For that reason the doctor may order a much more sensitive test called the Enzyme-Linked ImmunoSorbent Assay or ELISA test.

Less often, doctors make the diagnosis by looking at the lining of the small intestine with an instrument called an endoscope and taking samples from inside the intestine to be sent to a laboratory. This is done in more extreme cases, when a definite cause for the diarrhea hasn't been found.

Treatment

Giardiasis is treated with prescription medicines that kill the parasites. Treatment typically takes 5 to 7 days, and the medicine is usually given as a liquid that your child can drink. Some of these medicines may have side effects, so your doctor will tell you what to watch for.

If your child has giardiasis and your doctor has prescribed medication, be sure to give all doses on schedule for as long as your doctor directs. This will help your child recover faster and will kill parasites that might infect others in your family. Again, encourage all family members to wash their hands frequently, especially after using the bathroom and before eating.

A child who has diarrhea from giardiasis may lose too much fluid in the stool and become dehydrated. Make sure the child drinks plenty of fluids but no caffeinated beverages, because they make the body lose water faster.

Ask the doctor before you give your child any nonprescription drugs for cramps or diarrhea because these medicines may mask symptoms and interfere with treatment.

Duration

The incubation period for giardiasis is 1 to 3 weeks after exposure to the parasite. In most cases, treatment with 5 to 7 days of antiparasitic medication will help kids recover within a week's time. Medication also shortens the time that they're contagious. If giardiasis isn't treated, symptoms can last up to 6 weeks or longer.

When to Call the Doctor

Call the doctor whenever your child has:

large amounts of diarrhea, especially if he or she also has a fever and/or abdominal pain

occasional, small episodes of diarrhea that continue for several days, especially if appetite is poor, and your child is either gradually losing weight or isn't gaining as much as expected

Diarrhea

Most kids battle diarrhea from time to time, but the good news is that it's often caused by infections that don't last long and usually are more disruptive than dangerous. Still, it's important to know what to do to relieve and even prevent diarrhea.

Causes of Diarrhea

Diarrhea — frequent runny or watery bowel movements (poop) — is usually brought on by gastrointestinal (GI) infections caused by viruses, bacteria, or parasites.

The specific germs that cause diarrhea can vary among geographic regions depending on their level of sanitation, economic development, and hygiene. For example, developing countries with poor sanitation or where human waste is used as fertilizer often have outbreaks of diarrhea when intestinal bacteria or parasites contaminate crops or drinking water.

In developed countries, including the United States, diarrhea outbreaks are more often linked to contaminated water supplies, person-to-person contact in places such as child-care centers, or "food poisoning" (when people get sick from improperly processed or preserved foods contaminated with bacteria).

In general, infections that cause diarrhea are highly contagious. Most cases can be spread to others for as long as someone has diarrhea, and some infections can be contagious even longer.

Diarrheal infections can be spread through:

• dirty hands
• contaminated food or water
• some pets
• direct contact with fecal matter (i.e., from dirty diapers or the toilet)

Anything that the infectious germs come in contact with can become contaminated. This includes toys, changing tables, surfaces in restrooms, even the hands of someone preparing food. Kids can become infected by touching a contaminated surface, such as a toilet or toy, and then putting their fingers in their mouths.

A common cause of diarrhea is viral gastroenteritis (often called the "stomach flu," it also can cause nausea and vomiting). Many different viruses can cause viral gastroenteritis, which can pass through a household, school, or day-care center quickly because it's highly infectious. Although the symptoms usually last just a few days, affected kids (especially infants) who are unable to get adequate fluid intake can become dehydrated.

Rotavirus infection is a frequent cause of viral gastroenteritis in kids. Rotavirus usually causes explosive, watery diarrhea, although not all will show symptoms. Rotavirus has commonly caused outbreaks of diarrhea during the winter and early spring months, especially in child-care centers and children's hospitals, however, a vaccine now recommended for infants has been found to prevent approximately 75% of cases of rotavirus infection and 98% of the severe cases that require hospitalization.

Another group of viruses that can cause diarrhea in children, especially during the summer months, are enteroviruses, particularly coxsackievirus.

Bacteria and Parasites

Many different types of bacteria and parasites can cause GI and diarrhea. Here are a few that you may have heard about:

• E. coli bacteria: Most E. coli infections are spread through contaminated food or water, such as undercooked hamburgers or unwashed fruit that came into contact with animal manure. E. coli infections, which usually affect kids during their first few years of life, also can be spread via contaminated swimming water and petting zoos.

• Salmonella enteritidis bacteria: In the United States, these bacteria (found in contaminated raw or undercooked chicken and eggs) are a major cause of food poisoning, especially during summer.

• Campylobacter bacteria: Infants and young adults are most commonly affected by these infections, especially during the summer. The bacteria are often found in raw and undercooked chicken.

• Shigella bacteria: Shigella infection (called shigellosis) spreads easily in families, hospitals, and child-care centers. Kids 2 to 4 years old are the most likely to be infected.

• Giardia parasite: Infection with Giardia (called giardiasis) is easily spread through child-care settings and contaminated water supplies, especially water parks and pools (the bacteria are resistant to chlorine treatment), children's "touch tanks" in aquariums and museums, and contaminated streams or lakes.

• Cryptosporidium parasite: Found especially in drinking and recreational water, this parasite often is the culprit behind diarrhea epidemics in child-care centers and other public places. Cryptosporidiosis often causes watery diarrhea that can last for 2 weeks or more.

Diarrheal infections are a normal part of childhood for many kids, but diarrhea can be a symptom of a number of non-infectious diseases and conditions, especially when it lasts several weeks or longer. It can indicate food allergies, lactose intolerance, or diseases of the gastrointestinal tract, such as celiac disease and inflammatory bowel disease.

Signs and Symptoms

Symptoms typically start with crampy abdominal pain followed by diarrhea that usually lasts no more than a few days. Infections with many of the viruses, bacteria, and parasites that cause diarrhea also can bring on other symptoms, such as:

• fever
• loss of appetite
• nausea
• vomiting
• weight loss
• dehydration

In cases of viral gastroenteritis, kids often develop fever and vomiting first, followed by diarrhea.

Prevention

Although it's almost impossible to prevent kids from ever getting infections that cause diarrhea, here are some things to help lessen the likelihood:

• Make sure kids wash their hands well and often, especially after using the toilet and before eating. Hand washing is the most effective way to prevent diarrheal infections that are passed from person to person. Dirty hands carry infectious germs into the body when kids bite their nails, suck their thumbs, eat with their fingers, or put any part of their hands into their mouths.

• Keep bathroom surfaces clean to help prevent the spread of infectious germs.

• Wash fruits and vegetables thoroughly before eating, since food and water also can carry infectious germs.

• Wash kitchen counters and cooking utensils thoroughly after they've been in contact with raw meat, especially poultry.

• Refrigerate meats as soon as possible after bringing them home from the supermarket, and cook them until they're no longer pink. After meals, refrigerate all leftovers as soon as possible.

• Never drink from streams, springs, or lakes unless local health authorities have certified that the water is safe for drinking. In some developing countries, it may be safer to drink only bottled water and other drinks rather than water from a tap. Also, exercise caution when buying prepared foods from street vendors, especially if no local health agency oversees their operations.

• Don't wash pet cages or bowls in the same sink that you use to prepare family meals.

• Keep pets' feeding areas (especially those of reptiles) separate from family eating areas.

When to Call the Doctor

Call your doctor if your child has diarrhea and is younger than 6 months old or has:

• a severe or prolonged episode of diarrhea
• fever of 102°F or higher
• repeated vomiting, or refusal to drink fluids
• severe abdominal pain
• diarrhea that contains blood or mucus

Call the doctor immediately if your child seems to be dehydrated. Signs of dehydration include:

• dry or sticky mouth
• few or no tears when crying
• eyes that look sunken into the head
• soft spot (fontanelle) on top of the head that looks sunken
• lack of urine or wet diapers for 6 to 8 hours in an infant (or only a very small amount of dark yellow urine)
• lack of urine for 12 hours in an older child (or only a very small amount of dark yellow urine)
• dry, cool skin
• lethargy or irritability
• fatigue or dizziness in an older child

Caring for Your Child

Mild diarrhea is usually no cause for concern as long as your child is acting normally and drinking and eating enough. Mild diarrhea usually passes within a few days and kids recover completely with care at home, rest, and plenty of fluids.

A child with mild diarrhea who isn't dehydrated or vomiting can continue eating and drinking the usual foods and fluids, including breast milk or formula for infants and milk for kids over 1 year old. In fact, continuing a regular diet may even reduce the duration of the diarrhea episode, while also offering proper nutrition. Of course, you may want to give a child smaller portions of food until the diarrhea ends.

Antibiotics or antiviral medications are not prescribed for cases of diarrhea caused by bacteria and viruses because most kids recover on their own. But antibiotics are sometimes given to very young children or those with weak immune systems to prevent a bacterial infection (such as salmonellosis) from spreading through the body.

If the illness is caused by a parasite, it can be treated with antiparasitic medicines to cure or shorten the course of the illness. The doctor may order a stool test, in which a stool sample will be examined in the laboratory to see which specific germ is causing the diarrhea (bacteria, virus, or parasite).

Although you may be tempted to give your child an over-the-counter anti-diarrhea medication, don't do so unless your doctor gives the OK.

The primary concern when treating a diarrhea is the replacement of fluids and electrolytes (salts and minerals) lost from the body from diarrhea, vomiting, and fever. Depending on the amount of fluid loss and the severity of vomiting and diarrhea, your doctor will probably instruct you to:

• Continue your child's regular diet and give more liquids to replace those lost while the diarrhea continues if there are no signs of dehydration.

• Offer additional breastmilk or formula to infants.

• Use an oral rehydration solution (ORS) to replace lost fluids in non-dehydrated children.

Many of the "clear liquids" used by parents or recommended by doctors in the past are no longer considered appropriate for kids with diarrhea. Don't offer: plain water, soda, ginger ale, tea, fruit juice, gelatin desserts, chicken broth, or sports drinks. These don't have the right mix of sugar and salts and can even make diarrhea worse. Infants and small children should never be rehydrated with water alone because it doesn't contain adequate amounts of sodium, potassium, and other important minerals and nutrients.

Doctors often recommend that kids who show signs of mild dehydration be given oral rehydration solutions to replace body fluids quickly. These are available in most grocery stores and pharmacies without a prescription. Brand-name solutions often end in "lyte." Your doctor will tell you what kind to give, how much, and for how long. Never try to make your own ORS at home unless your doctor says it's OK and gives you a precise recipe.

In some cases, kids with severe diarrhea may need to receive IV fluids at the hospital for a few hours to help combat dehydration.

The best way to manage your child's diarrhea depends on how severe it is, what germ caused it, and your child's age, weight, and symptoms. So be sure to ask your doctor for recommendations about treatment.

Campylobacter Infections

Campylobacter bacteria, usually transmitted in contaminated food or water, can infect the gastrointestinal tract and cause diarrhea, fever, and cramps. Good hand-washing and food safety habits will help prevent Campylobacter infections (or campylobacteriosis), which usually clear up on their own but sometimes are treated with antibiotics.

Campylobacter infects over 2 million people each year, and it's a leading cause of diarrhea and food-borne illness. Babies under 1 year old, teens, and young adults are most commonly affected.

Causes

Campylobacter is found in the intestines of many wild and domestic animals. The bacteria are passed in their feces, which can lead to infection in humans via contaminated food, meats (especially chicken), water taken from contaminated sources (streams or rivers near where animals graze), and milk products that haven't been pasteurized.

Bacteria can be transmitted from person to person when someone comes into contact with fecal matter from an infected person, especially a child in diapers. Household pets can carry and transmit the bacteria to their owners.

Once inside the human digestive system, Campylobacter infects and attacks the lining of both the small and large intestines. The bacteria also can affect other parts of the body. In some cases — particularly in very young patients and those with chronic illnesses or a weak immune system — the bacteria can get into the bloodstream (called bacteremia). In rare cases, campylobacteriosis can lead to Guillain-Barré syndrome, a rare autoimmune disorder.

Symptoms

Symptoms usually appear 1 to 7 days after ingestion of the bacteria. The main symptoms of campylobacteriosis are fever, abdominal cramps, and mild to severe diarrhea. Diarrhea can lead to dehydration, which should be closely monitored. Signs of dehydration include: thirst, irritability, restlessness, lethargy, sunken eyes, dry mouth and tongue, dry skin, fewer trips to the bathroom to urinate, and (in infants) a dry diaper for several hours.

In cases of campylobacteriosis, the diarrhea is initially watery, but later may contain blood and mucus. Sometimes, the abdominal pain appears to be a more significant symptom than the diarrhea. When this happens, the infection may be mistaken for appendicitis or a problem with the pancreas.

Prevention

You can prevent campylobacteriosis by using drinking water that's been tested and approved for purity, especially in developing countries, and by drinking milk that's been pasteurized. While hiking and camping, avoid drinking water from streams and from sources that pass through land where animals graze.

Kill any bacteria in meats by cooking these foods thoroughly and eating while still warm. Whenever you prepare foods, wash your hands well before and after touching raw meats, especially poultry. Clean cutting boards, countertops, and utensils with soap and hot water after contact with raw meat.

As you care for a family member who has diarrhea, remember to wash your hands before touching other people in your household and before handling foods. Clean and disinfect toilets after they're used by the person with diarrhea. Also, if a pet dog or cat has diarrhea, wash your hands frequently and check with your veterinarian about treatment.

Diagnosis

Your doctor may send a stool sample to the lab to be tested for Campylobacter bacteria. Other lab tests may also be needed, especially if your child has blood in the stool.

Treatment

Most kids with campylobacteriosis will recover without medication. Occasionally, a doctor may prescribe an antibiotic, especially if the child is very young or the symptoms are severe or persistent. If your child receives an antibiotic, give it on schedule for as long as the doctor has ordered. Also, do not give nonprescription medicines for diarrhea without first checking with your doctor.

After being checked by a doctor, most kids with Campylobacter infections are treated at home, especially if they show no signs of being seriously dehydrated. They should drink plenty of fluids as long as the diarrhea lasts and be monitored for signs of dehydration.

Kids with mild diarrhea and no dehydration should continue to eat normally and increase their fluid intake — but fruit juices and soft drinks can worsen diarrhea and should be avoided. If your child is dehydrated, your doctor may recommend using an oral rehydration solution. Babies with campylobacteriosis who are breastfed should continue to be breastfed throughout the illness.

Diarrhea usually stops within 2 to 5 days. Full recovery usually takes about 1 week. In about 20% of cases, diarrhea can last longer or recur.

When to Call the Doctor

If your child has bloody or black, tar-like bowel movements or seems dehydrated, call your doctor immediately.

Ascariasis

Ascariasis is an intestinal infection caused by a parasitic roundworm. While it is the most common human infection caused by worms in the world, ascariasis is not common in the United States. It occurs in varying prevalence worldwide, with far greater frequency in areas with poor sanitation or crowded living conditions.

Signs and Symptoms

Although no symptoms may occur, the greater the number of worms involved in the infestation, the more severe a child's symptoms are likely to be. Kids are more likely than adults to develop gastrointestinal symptoms because they have smaller intestines and are at greater risk of developing intestinal obstruction.

Symptoms seen with mild infestation include:

• worms in stool
• coughing up worms
• loss of appetite
• fever
• wheezing

More severe infestations can result in more serious signs and symptoms, including:

• vomiting
• shortness of breath
• abdominal distention (swelling of the abdomen)
• severe stomach or abdominal pain
• intestinal blockage
• biliary tract blockage (includes the liver and gallbladder)

Description

Ascariasis occurs when worm eggs of the parasite Ascaris lumbricoides commonly found in soil and human feces are ingested. The eggs can be transmitted from contaminated food, drink, or soil. The roundworms range in size from 5.9 to 9.8 inches for adult males and 9.8 to 13.8 inches for adult females. The worms can grow to be as thick as a pencil and can live for 1 to 2 years.

Ascariasis is frequently found in developing countries where sanitary conditions are poor or in areas where human feces are used as fertilizer. When the eggs are swallowed and passed into the intestine, they hatch into larvae. The larvae then begin to move through the body.

Once they get through the intestinal wall, the larvae travel from the liver to the lungs through the bloodstream. During this stage, pulmonary symptoms such as coughing (even coughing up worms) may occur. In the lungs, the larvae climb up through the bronchial tubes to the throat, where they are swallowed. The larvae then return to the small intestine where they grow, mature, mate, and lay eggs. The worms reach maturity about 2 months after an egg is ingested from the soil.

Adult worms live and remain in the small intestine. A female worm can produce up to 240,000 eggs in a day, which are then discharged into the feces and incubate in the soil for weeks. Children are particularly susceptible to ascariasis because they tend to put things in their mouths, including dirt, and they often have poorer hygiene habits than adults.

Ascariasis is common in warmer or tropical climates, particularly in developing nations, where it can affect large segments of the population. Ascariasis is rare in the United States, due to strict sanitation rules and regulations.

Contagiousness

Ascariasis is not spread directly from one person to another. To become infected, an individual has to consume the worm's eggs.

Prevention

The most important measure of protection against ascariasis is the safe and sanitary disposal of human waste, which can transmit eggs. Areas of the world that use human feces as fertilizer must thoroughly cook all foods or clean them with a proper iodine solution (particularly fruits and vegetables).

Children who are adopted from developing nations are frequently screened for worms as a precautionary measure. Kids who live in underdeveloped areas of the world may be prescribed a preventive deworming medication.

These practices are recommended for all children:

• Try as much as possible to keep kids from putting things in their mouths.

• Teach kids to wash hands thoroughly and frequently, especially after using the bathroom and before eating.

Professional Treatment

The doctor will usually prescribe antiparasitic medication to be taken orally to kill the intestinal roundworms. Sometimes the stool will be re-examined about 3 weeks after treatment to check for eggs and worms. Symptoms usually disappear within 1 week of starting treatment.

Very rarely, surgical removal of the worms may be necessary (particularly in cases of intestinal or liver-related obstruction, or abdominal infection). A child who has ascariasis should be evaluated for other intestinal parasites, such as pinworm.

Home Treatment

• If your child has ascariasis, the medication prescribed should be administered accordingly. To prevent reinfection:

• Ensure that your child washes his or her hands properly, particularly after using the bathroom and before eating.

• Have your pets checked for worms regularly.

• Keep your child's fingernails short and clean.

• Sterilize any contaminated clothing, pajamas, and bedding.

• Evaluate the source of the infection. Additional sanitation measures in or around your home may be necessary.

When to Call the Doctor

If your child has any of the symptoms of ascariasis, contact your doctor right away. Stool samples will be sent to a laboratory to check for eggs and worms and confirm the diagnosis.

Call the doctor if symptoms do not improve with treatment or if new symptoms occur.

Appendicitis

Appendicitis (inflammation of the appendix) requires immediate medical attention, so it's important to learn its symptoms — and how they differ from a run-of-the-mill stomachache — so you can seek medical care right away.

The symptoms of appendicitis start with a mild fever and pain around the bellybutton, and can be accompanied by vomiting, diarrhea, or constipation. The stomach pain usually worsens and moves to the lower right side of the belly.

Call your doctor immediately if you suspect that your child has appendicitis. The earlier it's caught, the easier it will be to treat.

About Appendicitis

The appendix is a small finger-like organ that's attached to the large intestine in the lower right side of the abdomen. The inside of the appendix forms a cul-de-sac that usually opens into the large intestine. When that opening gets blocked, the appendix swells and can easily get infected by bacteria.

If the infected appendix isn't removed, it can burst and spread bacteria and infection throughout the abdomen and lead to serious health problems.

Appendicitis mostly affects kids between the ages of 11 and 20, and is rare in infants. Most cases of appendicitis occur between October and May. A family history of appendicitis may increase a child's risk, especially in males.

Symptoms

Call the doctor immediately if your child shows symptoms of appendicitis, including:

• significant abdominal pain, especially around the bellybutton or in the lower right part of the abdomen (perhaps coming and going and then becoming consistent and sharp)
• low-grade fever
• loss of appetite
• nausea and vomiting
• diarrhea (especially small amounts, with mucus)
• frequent urination and/or an abnormally strong urge to urinate
• swollen or bloated abdomen, especially in infants

There is no way to prevent appendicitis, but with sophisticated diagnostic tests and antibiotics, most cases are identified and treated without complications.

Diagnosis

Because the symptoms of appendicitis can be so similar to those of other medical conditions, it's often a challenge for doctors to diagnose it.

To confirm or rule out appendicitis, a doctor will examine the abdomen for signs of pain and tenderness, order blood and urine tests, X-rays of the abdomen and chest, and a CAT scan.

If the doctor suspects appendicitis, you may be told to stop giving your child any food or liquids in order to prepare for surgery.

Treatment

Appendicitis is treated by removing the inflamed appendix through an appendectomy. Surgeons usually either make a traditional incision in the abdomen or use a small surgical device (a laparoscope) that creates a smaller opening. An appendectomy usually requires a 2- to 3-day hospital stay.

Before and after surgery, intravenous (IV) fluids and antibiotics will help prevent complications and decrease the risk for wound infections after surgery. If needed, your child will also receive pain medication.

An infected appendix that bursts must still be removed surgically but might necessitate a longer hospital stay to allow antibiotics to kill any bacteria that have spread into the body.

If appendicitis goes untreated, the inflamed appendix can burst 24 to 72 hours after the symptoms begin. If the appendix has burst, the pain may spread across the whole abdomen, and the child's fever may be very high, reaching 104° Fahrenheit (40° Celsius).

The symptoms of appendicitis can vary according to a child's age. In kids 2 years old or younger, the most common symptoms are vomiting and a bloated or swollen abdomen, accompanied by pain.

If you suspect that your child has appendicitis, call your doctor immediately and don't give your child any pain medication or anything to eat or drink unless instructed to by the doctor.